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Does VL Reduce Mortality?

July 3, 2020

Written by Aaron Lacy

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This literature review again demonstrates that VL improves first-pass success rates in ED intubation. However, no strong evidence was found to show that VL reduces hypoxia or mortality when compared to DL. 

Why does this matter?
There is mounting evidence to support VL over DL to improve first-pass success rate in ED intubation. While first-pass success is thought to reduce peri-intubation complications such as time to intubation, esophageal intubations, and more, do these reductions translate to improved clinical outcomes?

Is VL your best BET?
Four papers identified as the highest level of evidence were reviewed to answer the question of whether using VL versus DL as first-line technique for ED intubation improved first-pass success rate or clinical outcomes. While VL versus DL was associated with a higher first-pass success rate and fewer esophageal intubations, it did not show a reduction in clinically relevant outcomes such as hypoxia, cardiac arrest, or in-hospital mortality.  This, paired with several studies that report little difference in first-pass success rate when VL is compared to DL in experienced operators, leads to their Best Evidence Topic (BET) report that while VL appears to improved first-pass success rate, senior/experienced operators should use whatever technique that are more familiar and comfortable with for ED intubation.

BET 2: Video laryngoscopy for patients requiring endotracheal intubation in the emergency department. Emerg Med J. 2020 Jun;37(6):381-383. doi: 10.1136/emermed-2020-209962.3.

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